Which of the following patients are at the highest risk for developing Hypernatremia a patient with?

1. A nurse is reviewing lab reports. The nurse recalls blood plasma is located in which of the following fluid compartments?
a.
Intracellular fluid (ICF)
b.
Extracellular fluid (ECF)
c.
Interstitial fluid
d.
Intravascular fluid

ANS: D
Blood plasma is the intravascular fluid.
ICF is fluid in the cells.
ECF is all the fluid outside the cells.
Interstitial fluid is fluid between the cells and outside the blood vessels.

A 35-year-old male weighs 70 kg. Approximately how much of this weight is ICF?
a.
5 L
b.
10 L
c.
28 L
d.
42 L

ANS: D
The total volume of body water for a 70-kg person is about 42 L.

5 L is incorrect because a 70-kg person has about 42 L of body water.

10 L is incorrect because a 70-kg person has about 42 L of body water.

28 L is incorrect because a 70-kg person has about 42 L of body water.

While planning care for elderly individuals, the nurse remembers the elderly are at a higher risk for developing dehydration because they have a(n):
a.
Higher total body water volume
b.
Decreased muscle mass
c.
Increase in thirst
d.
Increased tendency towards developing edema

ANS: B
The elderly are at higher risk for dehydration due to a decrease in muscle mass.
The elderly have a decrease in total body water, not an increase.
The elderly have a decrease in thirst.
The elderly may develop edema, but this does not lead to dehydration.

Which of the following patients should the nurse assess for a decreased oncotic pressure in the capillaries? A patient with:
a.
A high-protein diet
b.
Liver failure
c.
Low blood pressure
d.
Low blood glucose

B
Liver failure leads to lost or diminished plasma albumin production, and this contributes to decreased plasma oncotic pressure.
A high-protein diet would provide albumin for the maintenance of oncotic pressure.
Low blood pressure would lead to decreased hydrostatic pressure.
Decreased glucose does not affect oncotic pressure.

Water movement between the ICF and ECF compartments is determined by:
a.
Osmotic forces
b.
Plasma oncotic pressure
c.
Antidiuretic hormone
d.
Buffer systems

A
Osmotic forces determine water movement between the ECF and ICF compartments.
Oncotic pressure pulls water at the end of the capillary, which makes it move between intra and extra as interstitial is considered extra.
The antidiuretic hormone regulates water balance which would make water move between the intra and extra.
Buffer systems help regulate acid balance.

An experiment was designed to test the effects of the Starling forces on fluid movement. Which of the following alterations would result in fluid moving into the interstitial space?
a.
Increased capillary oncotic pressure
b.
Increased interstitial hydrostatic pressure
c.
Decreased capillary hydrostatic pressure
d.
Increased interstitial oncotic pressure

D
Increased interstitial oncotic pressure would attract water from the capillary into the interstitial space.
Increased capillary oncotic pressure would attract water from the interstitial space back into the capillary.
Increased interstitial hydrostatic pressure would attract movement of water from the interstitial spaces into the capillary.
Decreased capillary hydrostatic pressure would move water into the capillaries.

When planning care for a dehydrated patient, the nurse remembers the principle of water balance is closely related to _____ balance.
a.
Potassium
b.
Chloride
c.
Bicarbonate
d.
Sodium

D
Because water follows the osmotic gradients established by changes in salt concentration, water balance is tied to sodium balance.
Because water follows the osmotic gradients established by changes in salt concentration, water balance is tied to sodium balance, not potassium.
Because water follows the osmotic gradients established by changes in salt concentration, water balance is tied to sodium balance, not chloride.
Because water follows the osmotic gradients established by changes in salt concentration, water balance is tied to sodium balance, not bicarbonate.

A 70-year-old male with chronic renal failure presents with edema. Which of the following is the most likely cause of this condition?
a.
Increased capillary oncotic pressure
b.
Decreased interstitial oncotic pressure
c.
Increased capillary hydrostatic pressure
d.
Increased interstitial hydrostatic pressure

C
Increased capillary hydrostatic pressure would facilitate increased movement from the capillary to the interstitial space, leading to edema.
Increased capillary (plasma) oncotic pressure attracts water from the interstitial space back into the capillary.
Decreased interstitial oncotic pressure would keep water in the capillary.
Increased interstitial hydrostatic pressure would facilitate increased water movement from the interstitial space into the capillary.

A 10-year-old male is brought to the emergency room (ER) because he is incoherent and semiconscious. CT scan reveals that he is suffering from cerebral edema. This type of edema is referred to as:
a.
Localized edema
b.
Generalized edema
c.
Pitting edema
d.
Lymphedema

A
Cerebral edema is a form of localized edema.
Generalized edema is manifested by a more uniform distribution of fluid in interstitial spaces.
Pitting edema is due to a pit left in the skin.
Lymphedema is due to swelling in interstitial spaces, primarily in the extremities.

A nurse is teaching the staff about antidiuretic hormone (ADH). Which information should the nurse include? Secretion of ADH is stimulated by:
a.
Increased serum potassium
b.
Increased plasma osmolality
c.
Decreased renal blood flow
d.
Generalized edema

B
ADH is secreted when plasma osmolality increases or circulating blood volume decreases and blood pressure drops.
ADH is secreted when plasma osmolality increases, not by an increase in potassium.
ADH is secreted when plasma osmolality increases; it is not affected by decreased renal blood flow.
Edema does not affect the secretion of ADH.

Which statement by the staff indicates teaching was successful concerning aldosterone? Secretion of aldosterone results in:
a.
Decreased plasma osmolality
b.
Increased serum potassium levels
c.
Increased blood volume
d.
Localized edema

C
Aldosterone promotes renal sodium and water reabsorption and excretion of potassium, thus, increasing blood volume.
Aldosterone secretion would cause increased plasma osmolality.
Secretion of aldosterone decreases potassium levels because it causes potassium excretion.
Secretion of aldosterone does not promote the development of localized edema; it affects blood volume.

A 25-year-old male is diagnosed with a hormone-secreting tumor of the adrenal cortex. Which finding would the nurse expect to see in the lab results?
a.
Decreased blood volume
b.
Decreased blood K+ levels
c.
Increased urine Na+ levels
d.
Increased white blood cells

B
Aldosterone is secreted from the adrenal cortex. It promotes renal sodium and water reabsorption and excretion of potassium, leading to decreased potassium levels.
Blood volume actually increases with aldosterone secretion.
Aldosterone promotes sodium reabsorption, leading to normal or decreased Na+ levels.
Aldosterone is not associated with white blood cells.

A patient has been searching on the Internet about natriuretic hormones. When the patient asks the nurse what do these hormones do, how should the nurse respond? Natriuretic hormones affect the balance of:
a.
Calcium
b.
Sodium
c.
Magnesium
d.
Potassium

B
Natriuretic hormones are sometimes called a “third factor” in sodium regulation.
Natriuretic hormones are a factor in sodium balance, not calcium.
Natriuretic hormones are a factor in sodium balance, not magnesium.
Natriuretic hormones are a factor in sodium balance, not potassium.

A 5-year-old male presents to the ER with delirium and sunken eyes. After diagnosing him with severe dehydration, the primary care provider orders fluid replacement. The nurse administers a hypertonic intravenous solution. Which of the following would be expected?
a.
Symptoms subside quickly
b.
Increased ICF volume
c.
Decreased ECF volume
d.
Intracellular dehydration

D
A hypertonic solution would cause fluid to move into the extracellular space, leading to intracellular dehydration.
With this solution, his symptoms will not subside quickly because his cells will lose fluid.
His intracellular volume will decrease, not increase.
His extracellular volume will increase, not decrease.

Which of the following patients is the most at risk for developing hypernatremia? A patient with:
a.
Vomiting
b.
Diuretic use
c.
Dehydration
d.
Hypoaldosteronism

C
Dehydration leads to hypernatremia because an increase in sodium occurs with a net loss in water.
Vomiting leads to hyponatremia.
Diuretic use would lead to sodium loss.
Hypoaldosteronism leads to hyponatremia.

The most common cause of pure water deficit is:
a.
Renal water loss
b.
Hyperventilation
c.
Sodium loss
d.
Insufficient water intake

A
The most common cause of water loss is increased renal clearance of free water as a result of impaired tubular function.
Hyperventilation can cause water loss, but it is not the most common cause.
Sodium loss leads to hyponatremia, not pure water deficit.
Insufficient water intake causes hypernatremia, not water deficit.

Hyperlipidemia and hyperglycemia are associated with:
a.
Hypernatremia
b.
Hypertonic hyponatremia
c.
Hypokalemia
d.
Acidosis

B
Hypertonic hyponatremia develops with hyperlipidemia, hyperproteinemia, and hyperglycemia. Increases in plasma lipids displace water volume and decrease sodium concentration.
Hyperlipidemia and hyperglycemia are associated with hyponatremia, not hypernatremia.
Hyperlipidemia and hyperglycemia are associated with hyponatremia, not hypokalemia.
Hyperlipidemia and hyperglycemia are associated with hyponatremia, not acidosis.

A 52-year-old diabetic male presents to the ER with lethargy, confusion, and depressed reflexes. His wife indicates that he does not follow the prescribed diet and takes his medication sporadically. Lab results indicate hyperglycemia. Which assessment finding is most likely to occur?
a.
Clammy skin
b.
Decreased sodium
c.
Decreased urine formation
d.
Metabolic alkalosis

B
Hypertonic hyponatremia develops with hyperglycemia. Increases in plasma lipids displace water volume and decrease sodium concentration, leading to the symptoms described.
The patient is experiencing symptoms of hyponatremia and hyperglycemia, not hypernatremia and hypoglycemia.
The patient will have increased ECF and would have increased urine formation.
Metabolic acidosis would occur, not alkalosis.

When taking care of a patient with hyperkalemia, which principle is priority? Hyperkalemia causes a(n) _____ in resting membrane potential with _____ excitability of cardiac muscle.
a.
Increase; increased
b.
Decrease; increased
c.
Increase; decreased
d.
Decrease; decreased

A
Hyperkalemia causes an increase in resting membrane potential and increased excitability of cardiac muscle.
Hyperkalemia does cause an increased excitability of cardiac muscle, but the result is an increase in resting membrane potential.
Hyperkalemia does cause an increase in resting membrane potential, but the result is an increase in excitability of cardiac muscle.
Hyperkalemia causes an increase in resting membrane potential and increased excitability of cardiac muscle.

Which of the following patients is most prone to hypochloremia? A patient with:
a.
Hypernatremia
b.
Hypokalemia
c.
Hypercalcemia
d.
Increased bicarbonate intake

D
Hypochloremia is the result of elevated bicarbonate concentration, as occurs in metabolic alkalosis.
Hypochloremia is the result of hyponatremia, not hypernatremia.
Hypochloremia is the result of hyponatremia, not hypokalemia.
Hypochloremia is the result of hyponatremia, not hypercalcemia.

Which of the following conditions would cause the nurse to monitor for hyperkalemia?
a.
Excess aldosterone
b.
Acute acidosis
c.
Insulin usage
d.
Metabolic alkalosis

B
In acidosis, ECF hydrogen ions shift into the cells in exchange for ICF potassium and sodium; hyperkalemia and acidosis therefore often occur together.
Acidosis causes hyperkalemia, not excess aldosterone.
Insulin would help treat hyperkalemia, not cause it.
It is acidosis, not alkalosis, that leads to hyperkalemia.

Which organ system should the nurse monitor when the patient has long-term potassium deficits?
a.
Central nervous system (CNS)
b.
Lungs
c.
Kidneys
d.
Gastrointestinal tract

C
Long-term potassium deficits lasting more than 1 month may damage renal tissue, with interstitial fibrosis and tubular atrophy.
Long-term potassium deficits damage the kidneys, not the CNS.
Long-term potassium deficits damage the kidneys, not the lungs.
Long-term potassium deficits damage the kidneys, not the gastrointestinal tract.

A 42-year-old female presents to her primary care provider reporting muscle weakness and cardiac abnormalities. Laboratory tests indicate that she is hypokalemic. Which of the following could be the cause of her condition?
a.
Respiratory acidosis
b.
Constipation
c.
Hypoglycemia
d.
Primary hyperaldosteronism

D
Primary hyperaldosteronism, with excessive secretion of aldosterone from an adrenal adenoma (tumor) also causes potassium wasting.
Acidosis is related to hyperkalemia, not hypokalemia.
Constipation can occur with hypokalemia but does not cause it.
Hypoglycemia is not related to muscle weakness.

A 19-year-old male presents to his primary care provider reporting restlessness, muscle cramping, and diarrhea. Lab tests reveal that he is hyperkalemic. Which of the following could have caused his condition?
a.
Primary hyperaldosteronism
b.
Acidosis
c.
Insulin secretion
d.
Diuretic use

B
During acute acidosis, hydrogen ions accumulate in the ICF and potassium shifts out of the cell to the ECF, causing hyperkalemia.
Primary hyperaldosteronism is associated with hypokalemia, not hyperkalemia.
Insulin secretion helps reduce potassium levels in the cell, not cause it.
Diuretics would cause hypokalemia, not hyperkalemia.

A 60-year-old female is diagnosed with hyperkalemia. Which assessment finding should the nurse expect to observe?
a.
Weak pulse
b.
Excessive thirst
c.
Oliguria
d.
Constipation

ANS: C
Hyperkalemia is manifested by oliguria.
Hypokalemia is manifested by a weak pulse; it is not caused by hyperkalemia.
Hypokalemia is manifested by excessive thirst.
Diarrhea, not constipation, is a manifestation of hyperkalemia.

Which of the following buffer pairs is considered the major plasma buffering system?
a.
Protein/fat
b.
Carbonic acid/bicarbonate
c.
Sodium/potassium
d.
Amylase/albumin

B
The carbonic acid/bicarbonate buffer pair operates in both the lung and the kidney and is a major extracellular buffer.
Protein and fat are nutrients not related to the buffering system.
Sodium and potassium are electrolytes for fluid and electrolyte balance, not the major plasma buffering system for acid-base balance.
Amylase is a carbohydrate enzyme, and albumin is a protein; neither is a buffering system.

A nurse recalls regulation of acid-base balance through removal or retention of volatile acids is accomplished by the:
a.
Buffer systems
b.
Kidneys
c.
Lungs
d.
Liver

C
The volatile acid is carbonic acid (H2CO3), which readily dissociates into carbon dioxide (CO2) and water (H2O). The CO2 is then eliminated by the lungs.
Buffer systems are throughout the body and operate in the extracellular and intracellular systems.
The kidneys release hydrogen ions, not volatile acids.
The liver does not regulate acid-base balance.

Physiologic pH is maintained around 7.4 because carbonic acid and bicarbonate exist in a ratio of:
a.
20:1
b.
1:20
c.
10:2
d.
2:10

A
Normal carbonic acid to bicarbonate ratio is 20:1.
Normal carbonic acid to bicarbonate ratio is 20:1.

Which patient is most prone to metabolic alkalosis? A patient with:
a.
Retention of metabolic acids
b.
Hypoaldosteronism
c.
Excessive loss of chloride (Cl)
d.
Hyperventilation

C
When acid loss is caused by vomiting, renal compensation is not very effective because loss of Cl stimulates renal retention of bicarbonate, leading to alkalosis.
Retention of metabolic acids would lead to acidosis, not alkalosis.
Hypoaldosteronism leads to hyponatremia and does not cause alkalosis.
Hyperventilation leads to respiratory alkalosis, not metabolic alkalosis.

Which patient should the nurse assess for both hyperkalemia and metabolic acidosis? A patient diagnosed with:
a.
Diabetes insipidus
b.
Pulmonary disorders
c.
Cushing syndrome
d.
Renal failure

D
Renal failure is associated with hyperkalemia and metabolic acidosis.
Diabetes insipidus results in hypernatremia.
Pulmonary disorders are a cause of respiratory acidosis or alkalosis but do not affect hyperkalemia.
Cushing syndrome results in hypernatremia.

For a patient experiencing metabolic acidosis, the body will compensate by:
a.
Excreting H+ through the kidneys
b.
Hyperventilating
c.
Retaining CO2 in the lungs
d.
Secreting aldosterone

B
In an attempt to compensate for metabolic acidosis, the lungs hyperventilate to blow off CO2.
It is the lungs hyperventilating that would compensate for metabolic acidosis, not the kidneys.
CO2 retention would increase the acidotic state.
Aldosterone would conserve water, but does not help compensate for acidosis.

Which finding would support the diagnosis of respiratory acidosis?
a.
Vomiting
b.
Hyperventilation
c.
Pneumonia
d.
An increase in noncarbonic acids

C
Respiratory acidosis occurs with hypoventilation, and pneumonia leads to hypoventilation.
Vomiting leads to loss of acids and then to alkalosis.
Hyperventilation leads to respiratory alkalosis, not acidosis.
Metabolic acidosis is caused by an increase in noncarbonic acids.

A 54-year-old male with a long history of smoking complains of excessive tiredness, shortness of breath, and overall ill feelings. Lab results reveal decreased pH, increased CO2, and normal bicarbonate ion. These findings help to confirm the diagnosis of:
a.
Respiratory alkalosis
b.
Metabolic acidosis
c.
Respiratory acidosis
d.
Metabolic alkalosis

C
A decreased pH indicates acidosis. With increased CO2, it is respiratory acidosis.
The decreased pH indicates acidosis, not alkalosis.
It is acidosis, but the bicarbonate is normal, so it cannot be metabolic.
The decreased pH indicates acidosis, not alkalosis.

For a patient with respiratory acidosis, chronic compensation by the body will include:
a.
Kidney excretion of H+
b.
Kidney excretion of HCO3
c.
Prolonged exhalations to blow off CO2
d.
Protein buffering

A
The kidneys excrete H+ to compensate for respiratory acidosis.
The kidneys do not excrete HCO3 to compensate; this would increase acidosis.
Prolonged exhalations would not be effective for compensation, especially in a chronic state.
Protein buffering is intracellular and will not be effective enough to compensate for respiratory acidosis.

A 55-year-old female presents to her primary care provider and reports dizziness, confusion, and tingling in the extremities. Blood tests reveal an elevated pH, decreased PCO2, and slightly decreased HCO3. Which of the following is the most likely diagnosis?
a.
Respiratory alkalosis with renal compensation
b.
Respiratory acidosis with renal compensation
c.
Metabolic alkalosis with respiratory compensation
d.
Metabolic acidosis with respiratory compensation

A
With an elevated pH, the diagnosis must be alkalosis. Since the PCO2 is low, it is likely respiratory with a slight decrease in HCO3 indicating renal compensation.
With an elevated pH, the diagnosis must be alkalosis, not acidosis.
With an elevated pH, the diagnosis must be alkalosis. Since the PCO2 is low, it is likely respiratory since the HCO3 is decreased.
With an elevated pH, the diagnosis must be alkalosis.

Outcomes of laboratory tests include an elevated level of natriuretic peptides. Which organ is the priority assessment?
a.
Lungs
b.
Heart
c.
Liver
d.
Brain

B
Elevated natriuretic peptides indicate problems with the heart or the vasculature.
Elevated natriuretic peptides indicate problems with the heart or the vasculature, not the lungs.
Elevated natriuretic peptides indicate problems with the heart or the vasculature, not the liver.
Elevated natriuretic peptides indicate problems with the heart or the vasculature, not the brain.

A 60-year-old male with a 30-year history of smoking is diagnosed with a hormone-secreting lung tumor. Further testing indicates that the tumor secretes ADH. Which of the following assessment findings should the nurse expect? (Select all that apply.)
a.
Confusion
b.
Weakness
c.
Nausea
d.
Muscle twitching
e.
Weight loss

A, B, C, D
Secretion of ADH leads to water intoxication with symptoms of cerebral edema, with confusion and convulsions; weakness; nausea; muscle twitching; headache; and weight gain, not loss.

The nurse would anticipate the patient with syndrome of inappropriate ADH (SIADH) to demonstrate which of the following symptoms? (Select all that apply.)
a.
Weakness
b.
Nausea
c.
Headache
d.
Weight loss
e.
Muscle twitching

A, B, C, E
Weakness, nausea, muscle twitching, headache, and weight gain, not loss, are common symptoms of chronic water accumulation.

A nurse recalls direct stimulation of the insulin-secreting cells of the pancreas by the autonomic nervous system is an example of _____ control.
a.
Negative feedback
b.
Positive feedback
c.
Neural
d.
Substrate-level dependent

C
Direct stimulation of the insulin-secreting cells of the pancreas by the autonomic nervous system is a form of neural control.
Stimulation of the insulin cells of the pancreas by the autonomic nervous system is a form of neural control and is not regulated as a form of negative feedback. Negative feedback works like a thermostat.
Stimulation of the insulin cells of the pancreas by the autonomic nervous system is a form of neural control and is not regulated as a form of positive feedback.
Stimulation of the insulin cells of the pancreas by the autonomic nervous system is a form of neural control and is not substrate-level dependent.

A nurse is teaching staff about protein hormones. Which information should the nurse include? One of the protein hormones is:
a.
Thyroxine (T4)
b.
Aldosterone
c.
Testosterone
d.
Insulin

D
Protein hormones are also water-soluble hormones, and insulin is a part of this group.
Thyroxine is a lipid soluble hormone and is not a protein hormone.
Aldosterone is a lipid soluble hormone and is not a protein hormone.
Testosterone is a lipid soluble hormone and is not a protein hormone.

A 45-year-old female has elevated thyroxine production. Which of the following would accompany this condition?
a.
Increased thyroid-releasing hormone (TRH)
b.
Increased anterior pituitary stimulation
c.
Decreased T4
d.
Decreased thyroid-stimulating hormone (TSH)

D
Secretion of TSH stimulates the synthesis and secretion of thyroid hormones. Increasing levels of T4 and T3 then feed back negatively on the pituitary and hypothalamus to inhibit TRH and TSH synthesis.
With increased thyroxine production, TRH will be decreased.
Increased thyroxine would lead to decreased anterior pituitary stimulation.
Thyroxine is T4; its level will be elevated.

An endocrinologist isolated a new hormone and found it to be a water-soluble amine. Which of the following is most like this new hormone?
a.
Growth hormone (GH)
b.
Luteinizing hormone (LH)
c.
Antidiuretic hormone (ADH)
d.
Epinephrine

D
An example of a water-soluble amine is epinephrine.
GH is a water-soluble hormone but is a peptide.
LH is water-soluble hormone but is a polypeptide.
ADH is water-soluble hormone but is a polypeptide.

When insulin binds to its receptors on muscle cells, an increase in glucose uptake by the muscle cells occurs. This is an example of a _____ effect by a hormone.
a.
Pharmacologic
b.
Permissive
c.
Biphasic
d.
Direct

D
Direct effects are the obvious changes in cell function that result specifically from stimulation by a particular hormone as is true with insulin.
Pharmacologic effects are the result of high doses of a drug.
Permissive effects are less obvious hormone-induced changes that facilitate the maximal response or functioning of a cell.
Biphasic effects are twofold effects.

A 30-year-old male was diagnosed with hypothyroidism. Synthesis of which of the following would decrease in this patient?
a.
Corticosteroid B globulin
b.
Sex hormone-binding globulin
c.
Thyroid-binding globulin
d.
Albumin

C
TH is transported in the blood in bound and free forms. Most of the TH is transported bound to thyroxine-binding globulin (TBG); thus, if TH is low, the patient would also be low in TBG.
Thyroid-binding globulin is decreased with hypothyroidism, not corticosteroid B globulin.
Thyroid-binding globulin is decreased with hypothyroidism, not sex hormone-binding globulin.
Thyroid-binding globulin is decreased with hypothyroidism, not albumin.

A patient has high levels of hormones. To adapt to the high hormone concentrations, the patient’s target cells have the capacity for:
a.
Negative feedback
b.
Positive feedback
c.
Down-regulation
d.
Up-regulation

C
High concentrations of hormone decrease the number of receptors; this is called down-regulation; thus, the cell can adjust its sensitivity to the concentration of the signaling hormone.
Adaptation to high hormone concentration is the process of down-regulation. Negative feedback regulates hormone release.
Adaptation to high hormone concentration is the process of down-regulation. Positive feedback regulates some forms of hormone release.
Up-regulation is a response to low concentrations of hormone, thus increasing the number of receptors per cell.

A patient has researched lipid-soluble hormones on the Internet. Which information indicates the patient has a good understanding? Lipid-soluble hormone receptors cross the plasma membrane by:
a.
Diffusion
b.
Osmosis
c.
Active transport
d.
Endocytosis

A
Lipid-soluble hormones cross the plasma membrane by diffusion.
Lipid-soluble hormones cross by diffusion, not osmosis.
Lipid-soluble hormones cross by diffusion, not active transport.
Lipid-soluble hormones cross by diffusion, not endocytosis.

When a patient asks about target cell receptors, which is the nurse’s best response? Target cell receptors for most water-soluble hormones are located in the:
a.
Cytosol
b.
Cell membrane
c.
Endoplasmic reticulum
d.
Nucleus

B
Water-soluble hormones bind to cell surface receptors.
Water-soluble hormones bind to cell surface receptors, not cytosol.
Water-soluble hormones bind to cell surface receptors, not endoplasmic reticulum.
Water-soluble hormones bind to cell surface receptors, not the nucleus.

When the endocrinologist asks the staff how the releasing hormones that are made in the hypothalamus travel to the anterior pituitary, how should the staff reply? Via the:
a.
Vessels of the zona fasciculata
b.
Chromophils
c.
Median eminence
d.
Hypophysial portal system

D
Neurons in the hypothalamus secrete releasing hormones into veins that carry the releasing hormones directly to the vessels of the adenohypophysis via the hypophysial portal system, thus bypassing the normal circulatory route.
Zona fasciculata secretes abundant amounts of cortisol from the adrenal gland.
Chromophils are the secretory cells of the adenohypophysis.
The median eminence is a part of the posterior pituitary, not the anterior.

An aide asks the nurse what activates tyrosine. What is the nurse’s best response?
a.
GH
b.
PRL
c.
Insulin
d.
Estrogen

C
Insulin receptor binding activates tyrosine kinase autophosphorylation and sends a cascade of signals to activate glucose transporters.
Insulin binding, not growth hormone, activates tyrosine.
Insulin, not PRL, activates tyrosine.
Insulin, not estrogen, activates tyrosine.

A nurse recalls prolactin-inhibiting factor’s target tissue is the:
a.
Hypothalamus
b.
Anterior pituitary
c.
Mammary glands
d.
Posterior pituitary

B
Prolactin-inhibiting factor (PIF) inhibits prolactin secretion by the anterior pituitary.
PIF inhibits prolactin secretion by the anterior pituitary, not the hypothalamus.
PIF inhibits prolactin secretion by the anterior pituitary, not the mammary glands.
PIF inhibits prolactin secretion by the anterior pituitary, not the posterior pituitary.

When a staff member asks the nurse which gland secretes ADH and oxytocin, how should the nurse respond?
a.
Anterior pituitary
b.
Posterior pituitary
c.
Hypothalamus
d.
Pineal gland

B
The posterior pituitary secretes ADH, which also is called vasopressin, and oxytocin.
The anterior pituitary secretes ACTH, melanocyte-stimulating hormone (MSH), somatotropic hormones (GH, prolactin), and glycoprotein hormones—follicle-stimulating hormone (FSH), LH, and TSH.
The hypothalamus secretes PRF, which stimulates secretion of prolactin; PIF (dopamine), which inhibits prolactin secretion; TRH, which affects release of thyroid hormones; GH-releasing hormone (GHRH), which stimulates the release of GH; somatostatin, which inhibits the release of GH; gonadotropin-releasing hormone (GnRH), which facilitates release FSH and LH; corticotropin-releasing hormone (CRH), which facilitates the release of ACTH and endorphins; and substance P, which inhibits ACTH release and stimulates release of a variety of other hormones.
The pineal gland secretes melatonin.

If a patient’s posterior pituitary is removed, which hormone would the nurse expect to decrease?
a.
PRF
b.
ADH
c.
ACTH
d.
GH

B
The hormones ADH and oxytocin are released from the posterior pituitary gland.
PRF is released by the hypothalamus.
ACTH is released by the anterior pituitary.
GH is released by the hypothalamus.

Which principle should the nurse include while planning care for a patient with an ADH problem? ADH release from the posterior pituitary is stimulated by:
a.
Low blood pressure sensed by baroreceptors in the kidneys
b.
High serum osmolarity sensed by osmoreceptors in the hypothalamus
c.
Low osmolality sensed by osmoreceptors in the kidneys
d.
High concentration of potassium sensed by chemoreceptors in the carotid body

B
As plasma osmolality increases, these osmoreceptors are stimulated, the rate of ADH secretion increases, more water is reabsorbed from the kidney, and the plasma is diluted back to its set-point osmolality.
ADH release is stimulated by high serum osmolality, not lowered blood pressure.
ADH release is stimulated by high serum osmolality, not low osmolality.
ADH release is stimulated by high serum osmolality, not high concentrations of potassium

A patient wants to know why ADH is important in the body. What is the nurse’s best response? ADH is important in:
a.
The body’s water balance and urine concentration
b.
Maintaining electrolyte levels and concentrations
c.
Follicular maturation
d.
Regulation of metabolic processes

A
ADH is important in the body’s water balance and its ability to concentrate urine.
ADH aids in water balance, not electrolyte levels.
ADH aids in water balance, not follicular maturation.
ADH aids in water balance, not metabolic processes.

If a patient had a problem with the hypothalamus, which of the following hormones would be affected?
a.
ACTH
b.
Oxytocin
c.
ADH
d.
TSH

B
The hypothalamus secretes oxytocin.
The anterior pituitary secretes ACTH.
The posterior pituitary secretes ADH.
The anterior pituitary secretes TSH.

A nurse is teaching the staff about oxytocin. Which information should the nurse include? Target cells for oxytocin are located in the:
a.
Renal tubules
b.
Thymus
c.
Liver
d.
Uterus

D
Oxytocin causes uterine contraction and lactation in women and may have a role in sperm motility in men.
Oxytocin does not stimulate the renal tubules; it stimulates the uterus.
Oxytocin does not stimulate the thymus; it stimulates the uterus.
Oxytocin does not stimulate the liver; it stimulates the uterus.

A 50-year-old male patient is deficient in ADH production. Which of the following assessment findings would the nurse expect to find?
a.
Increased blood volume
b.
Increased urine osmolality
c.
Increased urine volume
d.
Increased arterial vasoconstriction

C
With deficient ADH, the kidneys would not concentrate urine leading to increased urine output.
Blood volume would decrease with increased renal excretion of fluid.
Urine osmolality would decrease.
Arteries would dilate with deficient ADH production.

A 70-year-old female has brittle bones secondary to osteoporosis. Her primary care provider prescribes calcitonin to:
a.
Activate vitamin D
b.
Stimulate osteoclastic activity
c.
Inhibit calcium resorption from bones
d.
Promote thyroid hormone release

C
Calcitonin lowers serum calcium levels by inhibition of bone-resorbing osteoclasts.
Calcitonin inhibits bone-resorbing osteoclasts; it does not activate vitamin D.
Calcitonin inhibits bone-resorbing osteoclasts; not stimulate it.
Calcitonin inhibits bone-resorbing osteoclasts; it does not promote thyroid hormone release.

Which nutrient would the nurse encourage the patient to consume for thyroid hormone synthesis?
a.
Zinc
b.
Sodium
c.
Iodine
d.
Calcium

C
Iodine is necessary for the synthesis of thyroid hormone.
Iodine, not zinc, is necessary for synthesis of thyroid hormone.
Iodine, not sodium, is necessary for synthesis of thyroid hormone.
Iodine, not calcium, is necessary for synthesis of thyroid hormone.

A nurse is reviewing lab results. Which of the following lab results would slow down the rate of parathyroid hormone secretion?
a.
Increased serum calcium levels
b.
Decreased serum calcium levels
c.
Decreased levels of TSH
d.
Increased levels of TSH

A
An increase in serum calcium inhibits parathyroid hormone (PTH) secretion.
An increase, not a decrease, in serum calcium inhibits PTH secretion.
Thyroid-stimulating hormone would not affect PTH secretion.
Thyroid-stimulating hormone would not affect PTH secretion.

A 40-year-old male undergoes surgery for a PTH-secreting tumor in which the parathyroid is removed. Which of the following would the nurse expect following surgery?
a.
Increased serum calcium
b.
Decreased bone formation
c.
Decreased calcium reabsorption in the kidney
d.
Increased calcitonin

C
PTH also acts on the kidney to increase calcium reabsorption and to decrease phosphate reabsorption.
Removal of the PTH-secreting tumor would result in decreased calcium reabsorption in the kidney, not increased serum calcium.
Removal of the PTH-secreting tumor would result in decreased calcium reabsorption in the kidney, not decreased bone formation.
Removal of the PTH-secreting tumor would result in decreased calcium reabsorption in the kidney, not increased calcitonin.

A nurse is teaching a patient about insulin. Which information should the nurse include? Insulin is primarily regulated by:
a.
Metabolic rate
b.
Serum glucose levels
c.
Prostaglandins
d.
Enzyme activation

B
Insulin secretion is promoted when blood levels of glucose rise.
Insulin secretion is not based on metabolic rate but on blood levels of glucose.
Insulin secretion is not based on prostaglandins but on blood levels of glucose.
Insulin secretion is not based on enzyme activation but on blood levels of glucose.

A 30-year-old male is diagnosed with a hormone-secreting tumor of the pancreas alpha cells. Which of the following would the nurse expect to be most likely increased in this patient?
a.
Amylin
b.
Glucagon
c.
Insulin
d.
Somatostatin

B
Glucagon is produced by the alpha cells of the pancreas.
Amylin is secreted by the beta cells.
Insulin is secreted by the beta cells.
Somatostatin is produced by the delta cells.

A nurse recalls insulin has an effect on which of the following groups of electrolytes?
a.
Sodium, chloride, phosphate
b.
Calcium, magnesium, potassium
c.
Hydrogen, bicarbonate, chloride
d.
Potassium, magnesium, phosphate

D
Insulin facilitates the intracellular transport of potassium (K+), phosphate, and magnesium.
Insulin facilitates the intracellular transport of potassium (K+), phosphate, and magnesium, not sodium and chloride.
Insulin facilitates the intracellular transport of potassium (K+), phosphate, and magnesium, not calcium.
Insulin facilitates the intracellular transport of potassium (K+), phosphate, and magnesium, not hydrogen, bicarbonate, and chloride.

A student asks the instructor which of the following is the most potent naturally occurring glucocorticoid. How should the instructor respond?
a.
Aldosterone
b.
Testosterone
c.
Cortisol
d.
Prolactin

C
The most potent naturally occurring glucocorticoid is cortisol.
The most potent naturally occurring glucocorticoid is cortisol, not aldosterone.
The most potent naturally occurring glucocorticoid is cortisol, not testosterone.
The most potent naturally occurring glucocorticoid is cortisol, not prolactin.

A patient wants to know what can cause ACTH to be released. How should the nurse respond?
a.
High serum levels of cortisol
b.
Hypotension
c.
Hypoglycemia
d.
Stress

D
Stress increases ACTH secretion.
ACTH regulates the release of cortisol from the adrenal cortex. It is not stimulated by high serum levels.
Hypotension does not stimulate ACTH.
Hypoglycemia does not stimulate ACTH.

A 39-year-old female is recovering from the birth of her third child. Which hormone would help prevent uterine bleeding?
a.
Aldosterone
b.
Cortisol
c.
Prolactin
d.
Oxytocin

D
Oxytocin functions near the end of labor to enhance effectiveness of contractions, promote delivery of the placenta, and stimulate postpartum uterine contractions, thereby preventing excessive bleeding.
Aldosterone regulates water balance.
Cortisol helps protect from stress.
Prolactin assists with milk production.

The nurse is teaching the staff about aldosterone. Which information should the nurse include? The main site of aldosterone synthesis is the:
a.
Liver
b.
Kidneys
c.
Adrenal cortex
d.
Hypothalamus

C
The adrenal cortex synthesizes aldosterone.
The adrenal cortex, not the liver, synthesizes aldosterone.
The adrenal cortex, not the kidneys, synthesizes aldosterone.
The adrenal cortex, not the hypothalamus, synthesizes aldosterone.

A 50-year-old male with one kidney had to undergo surgery for an adrenal tumor. His zona glomerulosa was largely removed during the surgery. The nurse would expect the removal of this tumor to result in a decrease in:
a.
Sodium
b.
Aldosterone
c.
Potassium
d.
Acid

B
The zona glomerulosa, the outer layer, constitutes about 15% of the cortex and primarily produces the mineralocorticoid aldosterone.
The zona glomerulosa produces aldosterone, not sodium.
The zona glomerulosa produces aldosterone, not potassium.
The zona glomerulosa produces aldosterone, not acid.

An endocrinologist is teaching about aldosterone secretion. Which information should the endocrinologist include? Aldosterone secretion is regulated by:
a.
The sympathetic nervous system
b.
ACTH feedback
c.
The renin-angiotension system
d.
Positive feedback

C
Aldosterone synthesis and secretion are regulated primarily by the renin-angiotensin system.
Aldosterone synthesis and secretion are regulated by the renin-angiotensin system, not the sympathetic nervous system.
Aldosterone synthesis and secretion are regulated by the renin-angiotensin system, not adrenocorticotropic hormone feedback.
Aldosterone synthesis and secretion are regulated by the renin-angiotensin system, not positive feedback.

If a patient had a problem with the adrenal medulla, which of the following hormones should the nurse monitor?
a.
Cortisol
b.
Epinephrine
c.
Androgens
d.
Estrogens

B
The major products stored and secreted by the adrenal medulla are the catecholamines epinephrine (adrenaline) and norepinephrine.
The adrenal cortex secretes cortisol.
The adrenal cortex secretes androgens.
The pituitary secretes estrogens.

When catecholamines are released in a patient, what should the nurse assess for?
a.
Nutrient absorption
b.
Fluid retention
c.
Hypotension
d.
Hyperglycemia

D
Catecholamines cause hyperglycemia and immune suppression.
Catecholamines cause hyperglycemia, not nutrient absorption.
Catecholamines cause hyperglycemia, not fluid retention.
Catecholamines cause hypertension, not hypotension.

If the patient has a problem with the pineal gland, which substance would the nurse monitor?
a.
Melatonin
b.
Epinephrine
c.
Cortisol
d.
Somatostatin

A
The pineal glands secrete melatonin.
The adrenal medulla secretes epinephrine.
The adrenal cortex secretes cortisol.
The thyroid gland secretes somatostatin.

Elevated levels of glucocorticoids result in which of the following assessment findings? (Select all that apply.)
a.
Polycythemia
b.
Increased appetite
c.
Weight loss
d.
Decreased calcium
e.
Increased height

A, B, D
Increased glucocorticoid secretion leads to polycythemia, increased appetite, fat deposition in the face and cervical areas, decreased serum calcium levels, and interference with the action of growth hormone so that somatic growth is inhibited. Weight gain and loss of height are expected.

A nurse is discussing endocrine system dysfunction with a patient. Which statement indicates the patient understood? Endocrine system dysfunction can result from hyposecretion, hypersecretion, or from:
a.
Abnormal receptor activity
b.
Abnormal hormone levels
c.
Increased synthesis of second messengers
d.
Extracellular electrolyte alterations

A
Dysfunction may result from abnormal cell receptor function or from altered intracellular response to the hormone-receptor complex.
Abnormal hormone levels can occur, but are not the cause.
Intracellular storage of hormones would not lead to dysfunction; receptor function does.
Extracellular electrolyte alterations may result from dysfunction, but it is not a cause.

An aide asks the nurse what is the most common cause of elevated levels of antidiuretic hormone (ADH) secretion. How should the nurse respond?
a.
Autoimmune disease
b.
Cancer
c.
Pregnancy
d.
Heart failure

B
The most common cause of elevated levels of ADH is cancer.
The most common cause of elevated levels of ADH is cancer, not autoimmune disorders.
The most common cause of elevated levels of ADH is cancer, not pregnancy.
The most common cause of elevated levels of ADH is cancer, not heart failure.

A 54-year-old patient with pulmonary tuberculosis (lung infection) is evaluated for syndrome of inappropriate ADH secretion (SIADH). Which of the following electrolyte imbalances would be expected in this patient?
a.
Hyponatremia
b.
Hyperkalemia
c.
Hypernatremia
d.
Hypokalemia

A
Hyponatremia occurs due to increased water reabsorption by kidneys.
Hyperkalemia does not occur, but hyponatremia occurs due to increased water reabsorption.
Sodium levels are lowered, with hyponatremia they are not elevated.
Hypokalemia does not occur; SIADH is a problem of sodium.

A 44-year-old patient with pulmonary tuberculosis (lung infection) is evaluated for SIADH. Which of the following assessment findings would be expected in this patient?
a.
Peripheral edema
b.
Tachycardia
c.
Low blood pressure
d.
Concentrated urine

D
Clinical manifestations of SIADH include urine that is inappropriately concentrated with respect to serum osmolarity.
Peripheral edema is not a symptom of SIADH; concentrated urine is.
Tachycardia is not a symptom of SIADH, but confusion and lethargy are.
Low blood pressure is not a symptom of SIADH, but gastrointestinal symptoms and dyspnea are.

A nurse is caring for a patient with SIADH. What severe complication should the nurse assess for?
a.
Stroke
b.
Diabetes insipidus
c.
Neurologic damage
d.
Renal failure

C
When the hyponatremia of SIADH becomes severe, 110 mEq/L to 115 mEq/L, confusion, lethargy, muscle twitching, convulsions, and severe and sometimes irreversible neurologic damage may occur.
Stoke is not associated with SIADH, but confusion and convulsions do occur.
Diabetes insipidus is not associated with SIADH, as it is manifested by increased urine output and in SIADH urine output decreases.
Neurological failure, not renal failure, occurs in SIADH.

A 22-year-old male is admitted to the intensive care unit with a closed head injury sustained in a motorcycle accident. The injury has caused severe damage to the posterior pituitary. Which of the following complications should the nurse anticipate?
a.
Dilutional hyponatremia
b.
Dehydration from polyuria
c.
Cardiac arrest from hyperkalemia
d.
Metabolic acidosis

B
Diabetes insipidus is a well-recognized complication of closed head injury and is manifested by polyuria leading to dehydration.
The patient will experience hypernatremia, not hyponatremia.
Electrolytes other than sodium are typically not affected with diabetes insipidus.
Acidosis is not associated with diabetes insipidus.

While planning care for a patient from general anesthesia, which principle should the nurse remember? A side effect of some general anesthetic agents is _____ diabetes insipidus.
a.
Neurogenic
b.
Nephrogenic
c.
Psychogenic
d.
Allogenic

B
General anesthetics can lead to nephrogenic diabetes insipidus.
General anesthetics can lead to nephrogenic, not neurogenic, diabetes insipidus; neurogenic diabetes may be due to primary brain tumors, hypophysectomy, aneurysms, thrombosis, infections, and immunologic disorders and head injury.
General anesthetics can lead to nephrogenic, not psychogenic, diabetes insipidus; psychogenic is due to ingestion of large quantities of fluid.
General anesthetics can lead to nephrogenic, not allogenic, diabetes insipidus.

Diabetes insipidus, diabetes mellitus (DM), and SIADH share which of the following assessment manifestations?
a.
Polyuria
b.
Edema
c.
Vomiting and abdominal cramping
d.
Thirst

D
All three share thirst as a common clinical manifestation.
SIADH does not have polyuria as a clinical manifestation.
Insipidus does not have edema as a clinical manifestation.
SIADH is manifested by gastrointestinal symptoms, the other two are not.

A 50-year-old male patient presents with polyuria and extreme thirst. He was given exogenous ADH. For which of the following conditions would this treatment be effective?
a.
Neurogenic diabetes insipidus
b.
Psychogenic diabetes insipidus
c.
Nephrogenic diabetes insipidus
d.
SIADH

A
Neurogenic diabetes insipidus is caused by the insufficient secretion of ADH; thus, exogenous ADH would be useful in the treatment of this disorder.
Psychogenic diabetes insipidus is due to increased intake of water and would not respond to exogenous ADH.
ADH is high in nephrogenic diabetes insipidus; thus, exogenous ADH would be contraindicated.
SIADH is manifested by high levels of ADH; thus, exogenous administration of ADH would be contraindicated.

A 25-year-old male presents with fatigue, constipation, and sexual dysfunction. Tests reveal all pituitary hormones are normal and no masses are present. The nurse suspects the most likely cause of his symptoms is a dysfunction in the:
a.
Anterior pituitary
b.
Posterior pituitary
c.
Pars intermedia
d.
Pituitary stalk

D
When pituitary hormones are normal, dysfunction in the action of hypothalamic hormones are most commonly related to interruption of the connection between the hypothalamus and pituitary, the pituitary stalk.
Pituitary hormones are normal so the dysfunction cannot be in the anterior pituitary.
Pituitary hormones are normal, so the dysfunction cannot be in the posterior pituitary.
Pituitary hormones are normal, so the dysfunction cannot be in the pars intermedia.

A 15-year-old female presents with breast discharge, dysmenorrhea, and excessive excitability. Tests reveal that all her pituitary hormones are elevated. What does the nurse suspect as the most likely cause for these assessment findings?
a.
A pituitary adenoma
b.
Hypothalamic hyposecretion
c.
Hypothalamic inflammation
d.
Pheochromocytoma

A
Hormonal effects of pituitary adenomas include hypersecretion from the adenoma, itself, and hyposecretion from surrounding pituitary cells; in this case prolactin would be elevated with the manifestation of menstrual irregularities and secretion from the breast.
These symptoms are indicative of hypersecretion, not hyposecretion.
These symptoms are indicative of hypersecretion, not hypothalamic inflammation, which would lead to hyposecretion.
Pheochromocytoma is a tumor of the adrenal gland and would be manifested by elevated blood pressure.

What common neurologic disturbances should the nurse assess for in a patient with a pituitary adenoma?
a.
Coma
b.
Visual disturbances
c.
Confused states
d.
Breathing abnormalities

B
The clinical manifestations of pituitary adenomas are visual changes including visual field impairments (often beginning in one eye and progressing to the other) and temporary blindness.
Coma is not associated with pituitary adenoma, visual disturbances are.
Confused states are not associated with pituitary adenoma, visual disturbances are.
Breathing abnormalities are not associated with pituitary adenoma, visual disturbances are.

A 35-year-old female with Graves disease is admitted to a medical-surgical unit. While the nurse is reviewing the lab tests, which results would the nurse expect to find?
a.
High levels of circulating thyroid-stimulating antibodies
b.
Ectopic secretion of thyroid-stimulating hormone (TSH)
c.
Low circulating levels of thyroid hormones
d.
Increased circulation of iodine

A
Graves disease results from a form of Type II hypersensitivity in which there is stimulation of the thyroid by autoantibodies directed against the TSH receptor.
The thyroid-stimulating antibodies stimulate TSH receptors; it is not an ectopic secretion.
Graves disease is manifested by elevated levels of thyroid hormones.
Iodine deficiency leads to goiter, but not Graves disease.

While checking the lab results for a patient with Graves disease, the nurse would check the T3 level to be abnormally:
a.
Low
b.
High
c.
Variable
d.
Absent

B
T3 levels are elevated in Graves disease.
T3 levels are elevated in Graves disease.
T3 levels are elevated in Graves disease, not variable.
T3 levels are elevated in Graves disease, not absent.

A 35-year-old female with Graves disease is admitted to a medical-surgical unit. Which of the following symptoms would the nurse expect to find before treatment?
a.
Weight gain, cold intolerance
b.
Slow heart rate, rash
c.
Skin hot and moist, rapid heart rate
d.
Constipation, confusion

C
Symptoms of Graves disease include heat intolerance and increased tissue sensitivity to stimulation by the sympathetic division of the autonomic nervous system.
Weight loss, rather than weight gain, and heat intolerance would result.
Tachycardia, not slow heart rate, would occur.
Diarrhea would occur as opposed to constipation.

Visual disturbances are a common occurrence in patients with untreated Graves disease. The endocrinologist explains to the patient that the main cause of these complications is:
a.
Decreased blood flow to the eye
b.
Orbital edema and protrusion of the eyeball
c.
TSH neurotoxicity to retinal cells
d.
Local lactic acidosis

B
Visual disturbances with Graves disease include orbital fat accumulation, inflammation, and edema of the orbital contents resulting in exophthalmos (protrusion of the eyeball), periorbital edema, and extraocular muscle weakness leading to diplopia (double vision).
Blood flow to the eye is not an effect, but visual changes occur.
Functional abilities of the eye results from hyperactivity of the sympathetic system.
Lactic acid is not involved with visual changes in the eye.

A 25-year-old female with Graves disease is admitted to a medical-surgical unit. Palpation of her neck would most likely reveal:
a.
A normal-sized thyroid
b.
A small discrete thyroid nodule
c.
Multiple discrete thyroid nodules
d.
Diffuse thyroid enlargement

D
A patient with Graves disease would reveal stimulation of the gland causing diffuse thyroid enlargement.
In Graves disease, the thyroid will be enlarged, not normal sized.
In Graves disease, the entire gland will be enlarged, not just a small nodule.
In Graves disease, the entire gland will be enlarged, not multiple discrete nodules.

A 22-year-old female has a low level of TSH. What condition does the nurse expect the patient is experiencing?
a.
Primary hypothyroidism
b.
Secondary hypothyroidism
c.
Autoimmune hypothyroidism
d.
Atypical hypothyroidism

B
Causes of secondary hypothyroidism are related to either pituitary or hypothalamic failure, which would be evident by low levels of TSH.
Primary hypothyroidism would be evident by elevated levels of TSH.
Autoimmune hypothyroidism would be evident by elevated TSH.
Atypical hypothyroidism would be evident by normal or elevated TSH.

While planning care for a patient with hypothyroidism, which principle should the nurse remember? The basal metabolic rate is unusually _____ with hypothyroidism.
a.
High
b.
Low
c.
Steady
d.
Variable

B
The metabolic rate with hypothyroidism is low.
The metabolic rate with hypothyroidism is low, not high.
The metabolic rate with hypothyroidism is low, not steady.
The metabolic rate with hypothyroidism is low, not variable.

A 3-year-old male was diagnosed with congenital hypothyroidism. The parents ask the nurse if left untreated what will happen. What is the nurse’s best response? If left untreated, the child would have:
a.
Mental retardation and stunted growth
b.
Increased risk of childhood thyroid cancer
c.
Hyperactivity and attention deficit disorder
d.
Liver, kidney, and pancreas failure

A
Cognitive disability varies with the severity of congenital hypothyroidism and the length of delay before treatment is initiated.
Cognitive disability varies with the severity of congenital hypothyroidism and the length of delay before treatment is initiated. There is not an increased risk for thyroid cancer.
Cognitive disability varies with the severity of congenital hypothyroidism and the length of delay before treatment is initiated. There is not a risk for hyperactivity and attention deficit disorder.
Cognitive disability varies with the severity of congenital hypothyroidism and the length of delay before treatment is initiated. There is not a risk for liver, kidney, and pancreas failure.

A 30-year-old male was diagnosed with thyroid carcinoma. The lab tests the nurse would most likely find are _____ T3 and T4 levels.
a.
High
b.
Low
c.
Normal
d.
Variable

C
Most individuals with thyroid carcinoma have normal T3 and T4 levels and are therefore euthyroid.
Most individuals with thyroid carcinoma have normal T3 and T4 levels and are therefore euthyroid, not hyperthyroid.
Most individuals with thyroid carcinoma have normal T3 and T4 levels and are therefore euthyroid, not hypothyroid.
Most individuals with thyroid carcinoma have normal T3 and T4 levels and are therefore euthyroid, not variable in their levels.

What problem should the nurse assess for in a patient with chronic hyperparathyroidism?
a.
Seizure disorders
b.
Vitamin D malabsorption
c.
Hyponatremia
d.
Osteoporosis and pathologic fractures

D
Excessive osteoclastic and osteocytic activity resulting in bone resorption may cause pathologic fractures, kyphosis of the dorsal spine, and compression fractures of the vertebral bodies.
Pathologic fractures are associated with chronic hyperparathyroidism, not a seizure disorder.
Pathologic fractures are associated with chronic hyperparathyroidism, not vitamin D malabsorption.
Pathologic fractures are associated with chronic hyperparathyroidism, not hyponatremia.

A 45-year-old female with Graves disease underwent surgical removal of her thyroid gland. During the postoperative period, her serum calcium was low. The most probable reason for her low serum calcium is:
a.
Hyperparathyroidism secondary to Graves disease
b.
Myxedema secondary to surgery
c.
Hypoparathyroidism caused by surgical injury to the parathyroid glands
d.
Hypothyroidism resulting from lack of thyroid replacement

C
Hypoparathyroidism is most commonly caused by damage to the parathyroid glands during thyroid surgery.
Hypoparathyroidism is most commonly caused by damage to the parathyroid glands during thyroid surgery, not secondary to Graves disease.
Hypoparathyroidism is most commonly caused by damage to the parathyroid glands during thyroid surgery, not due to myxedema.
Hypoparathyroidism is most commonly caused by damage to the parathyroid glands during thyroid surgery; it does not result from the lack of thyroid replacement.

A 30-year-old female with Graves disease is admitted to a hospital unit for the surgical removal of her thyroid gland. During the postoperative period, the nurse notes that the patient’s serum calcium is low. The nurse should observe the patient for which of the following signs/symptoms?
a.
Muscle weakness and constipation
b.
Laryngeal spasms and hyperreflexia
c.
Abdominal pain and fever
d.
Anorexia, nausea, and vomiting

B
Symptoms of low calcium are associated with tetany, a condition characterized by muscle spasms, hyperreflexia, clonic-tonic convulsions, and laryngeal spasms.
Symptoms of low calcium are associated with tetany, a condition characterized by muscle spasms, hyperreflexia, clonic-tonic convulsions, and laryngeal spasms. It does not involve muscle weakness and constipation.
Symptoms of low calcium are associated with tetany, a condition characterized by muscle spasms, hyperreflexia, clonic-tonic convulsions, and laryngeal spasms. It does not cause abdominal pain.
Symptoms of low calcium are associated with tetany, a condition characterized by muscle spasms, hyperreflexia, clonic-tonic convulsions, and laryngeal spasms. It does not cause anorexia, nausea, or vomiting.

When a patient wants to know what most commonly causes hypoparathyroidism, how should the nurse reply? It is most commonly caused by:
a.
Pituitary hyposecretion
b.
Parathyroid adenoma
c.
Parathyroid gland injury
d.
Hypothalamic inactivity

C
Hypoparathyroidism is most commonly caused by damage to the parathyroid glands.
Hypoparathyroidism is most commonly caused by damage to the parathyroid glands, not pituitary hyposecretion.
Hypoparathyroidism is most commonly caused by damage to the parathyroid glands, not parathyroid adenoma.
Hypoparathyroidism is most commonly caused by damage to the parathyroid glands, not inactivity of the hypothalamus.

A 25-year-old male presents to his primary care provider reporting changes in facial features. CT scan reveals a mass on the anterior pituitary, and lab tests reveal severely elevated growth hormone (GH). Which of the following would the nurse also expect to find?
a.
Decreased IGF-1
b.
Hypotension
c.
Sexual dysfunction
d.
Height increases

C
In addition to elevated levels of GH, sexual dysfunction in men can occur.
In addition to elevated levels of GH, sexual dysfunction in men can occur, and IGF-1 increases.
In addition to elevated levels of GH, sexual dysfunction in men can occur, not hypotension.
In addition to elevated levels of GH, sexual dysfunction in men can occur, and overgrowth of bone occurs but not an increase in height.

A 30-year-old male presents to his primary care provider reporting visual disturbances. CT reveals a pituitary tumor and lab tests reveal elevated prolactin. He is diagnosed with prolactinoma. Which of the following treatments would the nurse help implement? Administering:
a.
Dopaminergic agonists
b.
Calcium
c.
Insulin
d.
Radiation

A
Dopaminergic agonists (bromocriptine and cabergoline) are the treatment of choice for prolactinomas.
Calcium is used to treat parathyroid disease.
Insulin is used to treat diabetes.
Radiation is used to treat GH.

A 12-year-old female is newly diagnosed with type 1 DM. When the parents ask what causes this, what is the nurse’s best response?
a.
A familial, autosomal dominant gene defect
b.
Obesity and lack of exercise
c.
Immune destruction of the pancreas
d.
Hyperglycemia from eating too many sweets

C
The most common cause of type 1 DM is a slowly progressive autoimmune T cell-mediated disease that destroys the beta cells of the pancreas.
The most common cause of type 1 DM is a slowly progressive autoimmune T cell-mediated disease that destroys the beta cells of the pancreas; it is not due to a gene defect.
Although obesity can contribute to diabetes, the most common cause of type 1 DM is a slowly progressive autoimmune T cell-mediated disease that destroys the beta cells of the pancreas.
Eating too many sweets does not contribute to the development of diabetes; the most common cause of type 1 DM is a slowly progressive autoimmune T cell-mediated disease that destroys the beta cells of the pancreas.

A 12-year-old male is newly diagnosed with type 1 DM. Which of the following tests should the nurse prepare the patient to best confirm the diagnosis?
a.
Fasting plasma glucose levels
b.
Random serum glucose levels
c.
Genetic testing
d.
Glycosylated hemoglobin measurements

A
Fasting blood glucose levels are most beneficial in confirming the diagnosis of diabetes.
Random serum levels are not as accurate as fasting.
Genetic testing may be important for future determination, but it does not confirm the diagnosis.
Glycosylated testing measures glucose control over time.

An 11-year-old male is newly diagnosed with type 1 DM. Which classic symptoms should the nurse assess the patient for?
a.
Recurrent infections, visual changes, fatigue, and paresthesias
b.
Polydipsia, polyuria, polyphagia, and weight loss
c.
Vomiting; abdominal pain; sweet, fruity breath; dehydration; and Kussmaul breathing
d.
Weakness, vomiting, hypotension, and mental confusion

B
Classic symptoms of type 1 DM include polydipsia, polyuria, polyphagia, and weight loss.
Recurrent infections and visual changes are complications of diabetes.
Vomiting, abdominal pain, and sweet breath are signs of diabetic ketoacidosis.
Weakness, hypotension, and mental confusion are signs of hypoglycemia.

A 19-year-old female with type 1 DM was admitted to the hospital with altered consciousness and the following lab values: serum glucose 500 mg/dl (high) and serum K+ 2 (low). Her parents state that she has been sick with the “flu” for a week. The diagnosis is hyperosmolar hyperglycemia nonketotic syndrome (HHNKS). What relationship do these values have with her insulin deficiency?
a.
Increased glucose utilization causes the shift of fluid from the intravascular to the intracellular space.
b.
Decreased insulin causes hyperglycemia and osmotic diuresis.
c.
Increased glucose and fatty acid metabolism stimulates renal diuresis and electrolyte loss.
d.
Increased insulin use results in protein catabolism, tissue wasting, and electrolyte loss.

B
Because the amount of insulin required to inhibit fat breakdown is less than that needed for effective glucose transport, insulin levels are sufficient to prevent excessive lipolysis and ketosis.
Volume is depleted, not increased.
Electrolyte loss does occur, but it is not due to fatty acids and glucose metabolism, it is due to insufficient insulin.
Insulin is decreased, not increased.

A nurse is reviewing lab results for glycosylated hemoglobin (hemoglobin A1c) levels. A nurse recalls the purpose of this test is to:
a.
Measure fasting glucose levels.
b.
Monitor long-term serum glucose control.
c.
Detect acute complications of diabetes.
d.
Check for hyperlipidemia.

B
Glycosylated hemoglobin refers to the permanent attachment of glucose to hemoglobin molecules and reflects the average plasma glucose exposure over the life of a red blood cell (approximately 120 days).
Glycosylated hemoglobin does not measure fasting, but glucose control over time.
Glycosylated hemoglobin does not identify complications, but could provide data if the patient is at risk.
Glycosylated does not check for hyperlipidemia.

When a patient asks what causes hyperglycemia in type 2 DM, how should the nurse respond? Hyperglycemia is a result of:
a.
Insulin deficiency
b.
Hyperinsulinemia
c.
Glucagon deficiency
d.
Liver dysfunction

B
Type 2 diabetes is due to hyperinsulinemia and insulin resistance.
Type 1 is due to insulin deficiency; type 2 is due to insulin resistance.
Type 2 diabetes is due to hyperinsulinemia and insulin resistance, not glucagon deficiency.
Type 2 diabetes is due to hyperinsulinemia, not liver dysfunction.

A 19-year-old female with type 1 DM was admitted to the hospital with the following lab values: serum glucose 500 mg/dl (high), urine glucose and ketones 4+ (high), and arterial pH 7.20 (low). Her parents state that she has been sick with the “flu” for a week. Which of the following statements best explains her acidotic state?
a.
Increased insulin levels promote protein breakdown and ketone formation.
b.
Her uncontrolled diabetes has led to renal failure.
c.
Low serum insulin promotes lipid storage and a corresponding release of ketones.
d.
Insulin deficiency promotes lipid metabolism and ketone formation.

D
With insulin deficiency, lipolysis is enhanced, and there is an increase in the amount of nonesterified fatty acids delivered to the liver. The consequence is increased glyconeogenesis contributing to hyperglycemia and production of ketone bodies (acetoacetate, hydroxybutyrate, and acetone) by the mitochondria of the liver at a rate that exceeds peripheral use.
Insulin is deficient, not increased.
The patient is in acidosis, not renal failure.
Insulin is low, but the ketones are the result of fatty acid breakdown due to lack of insulin, not because of lipid storage.

A 13-year-old male who uses insulin to control his type 1 diabetes experiences hunger, lightheadedness, tachycardia, pallor, headache, and confusion during gym class. The most probable cause of these symptoms is:
a.
Hyperglycemia resulting from incorrect insulin administration
b.
Dawn phenomenon caused by eating a snack before gym class
c.
Hypoglycemia caused by increased exercise
d.
Somogyi effect caused by insulin sensitivity

C
The boy is experiencing hypoglycemia due to increased glucose utilization with exercise.
The boy is experiencing hypoglycemia, not hyperglycemia.
The boy is experiencing hypoglycemia, not dawn phenomenon, which occurs as an early morning rise in blood glucose concentration with no hypoglycemia during the night.
The Somogyi effect is a combination of hypoglycemia with rebound hyperglycemia.

A 55-year-old female is admitted to the medical unit for complications of long-term, poorly controlled type 2 DM. Which of the following would the nurse expect to find in addition to elevated glucose?
a.
Atherosclerosis
b.
Metabolic alkalosis
c.
Elevated liver enzymes
d.
Anemia

A
Macrovascular disease (lesions in large and medium sized arteries) increases morbidity and mortality and increases risk for accelerated atherosclerosis.
Acidosis, rather than alkalosis, would occur in this patient.
Elevated enzymes do not occur, but atherosclerosis does.
Anemia would not be expected, but atherosclerosis is.

When a staff member asks the nurse what causes the chronic complications of DM such as microvascular and macrovascular disease, how should the nurse respond? These complications are primarily related to:
a.
Pancreatic changes
b.
Hyperglycemia
c.
Ketone toxicity
d.
Hyperinsulinemia

B
The underlying cause of the micro and macro diseases associated with diabetes is due to hyperglycemia.
The underlying cause of the micro and macro diseases is related to hyperglycemia, not pancreatic changes.
The underlying cause of the micro and macro diseases is related to hyperglycemia, not ketone toxicity.
The underlying cause of the micro and macro diseases is related to hyperglycemia, not hyperinsulinemia.

A nurse checks lab results as both Cushing syndrome and Addison disease can manifest with elevated levels of:
a.
ADH
b.
Cortisol
c.
Adrenocorticotropic hormone (ACTH)
d.
Aldosterone

C
Cushing syndrome and Addison are related to elevated levels of ACTH.
Cushing syndrome and Addison are related to elevated levels of ACTH, not ADH.
Cushing syndrome and Addison are related to elevated levels of ACTH, not cortisol.
Cushing syndrome and Addison are related to elevated levels of ACTH, not aldosterone.

Which of the following alterations would the nurse expect to find in a patient with untreated Cushing disease or syndrome?
a.
Bradycardia
b.
Tachypnea
c.
Hyperkalemia
d.
Hypertension

D
With elevated cortisol levels, vascular sensitivity to catecholamines increases significantly, leading to vasoconstriction and hypertension.
Tachycardia is more likely than bradycardia due to increased sensitivity to catecholamines.
Tachypnea does not occur; the patient experiences hypertension.
Hyokalemia, not hyperkalemia, occurs.

When a nurse is assessing the physical features of individuals with Cushing syndrome, these findings will include:
a.
Weight loss and muscle wasting
b.
Truncal obesity and moon face
c.
Pallor and swollen tongue
d.
Depigmented skin and eyelid lag

B
Weight gain is the most common feature and results from the accumulation of adipose tissue in the trunk, facial, and cervical areas. These characteristic patterns of fat deposition have been described as “truncal obesity,” “moon face,” and “buffalo hump.”
Weight gain, not loss, is the most common feature of Cushing syndrome.
Pallor is not associated with Cushing syndrome.
The skin of the patient with Cushing syndrome is bronze in color.

A 35-year-old female took corticosteroid therapy for several months. Which of the following would the nurse expect to find?
a.
Renal toxicity
b.
Episodes of hypoglycemia
c.
Hypotension
d.
Type 2 DM

D
Overt DM develops in approximately 20% of individuals with hypercortisolism.
Diabetes develops, not renal toxicity.
Hypoglycemia does not occur; hyperglycemia does.
Hypertension, not hypotension, occurs; hypotension occurs with Addison.

A nurse is preparing to teach a patient about Addison disease. Which information should the nurse include? The most common cause of Addison disease is:
a.
An autoimmune reaction
b.
Dietary deficiency of sodium and potassium
c.
Cancer
d.
Viral infection of the pituitary gland

A
Addison disease is caused by autoimmune mechanisms that destroy adrenal cortical cells and is more common in women.
Addison disease is an autoimmune disorder and is not due to dietary deficiency.
Addison disease is an autoimmune disorder and is not due to cancer.
Addison disease is an autoimmune disorder and is not due to a viral infection.

A 50-year-old female presents with lightheadedness and overall abnormal feelings. Hyperaldosteronism is diagnosed. Which of the following symptoms would the nurse expect?
a.
Hypovolemia
b.
Hypotension
c.
Hypokalemia
d.
Hyponatremia

C
Hypokalemia occurs due to increased renal secretion of potassium.
Hypervolemia, not hypovolemia, occurs.
Hypertension, not hypotension, occurs.
Hypernatremia, not hyponatremia, occurs.

A 49-year-old female is diagnosed with hypercortisolism. Which of the following would the nurse expect?
a.
Weight loss
b.
Hypoglycemia
c.
Decreased urination
d.
Osteoporosis

D
The effects of hypercortisolism in bone cause loss of the protein matrix leading to osteoporosis, with pathologic fractures, vertebral compression fractures, bone and back pain, kyphosis, and reduced height.
Weight gain occurs especially in the face and upper back with hypercortisolism.
Hyperglycemia occurs even leading to diabetes in hypercortisolism.
Polyuria, or increased urination, occurs in association with hypercortisolism.

The body’s inability to conserve water and sodium when affected by Addison disease is explained by which of the following conditions?
a.
Elevated levels of cortisol
b.
Decreased levels of ACTH
c.
Hypersecretion of ADH
d.
Aldosterone deficiency

D
The symptoms of Addison disease are primarily a result of hypocortisolism and hypoaldosteronism.
The symptoms of Addison disease are primarily a result of hypocortisolism and hypoaldosteronism, not elevated levels of cortisol.
Addison disease is characterized by inadequate corticosteroid and mineralocorticoid synthesis and elevated serum ACTH.
ADH does not play a role in Addison disease.

A patient with Addison disease has weakness and easy fatigability. A nurse recalls this is due to:
a.
Hyperkalemia
b.
Hypoglycemia
c.
Hypocortisolism
d.
Metabolic acidosis

C
With mild to moderate hypocortisolism, symptoms usually begin with weakness and easy fatigability.
The weakness is due to hypocortisolism, not hyperkalemia.
The weakness is due to hypocortisolism, not hypoglycemia.
The weakness is due to hypocortisolism, not metabolic acidosis.

What is the cause of the hyperpigmentation seen in people with Cushing syndrome?
a.
Abnormal levels of cortisol
b.
Permissive effects of aldosterone when cortisol levels are altered
c.
Elevated levels of ACTH
d.
Hypersensitivity of melanocytes with sun exposure

C
Bronze or brownish hyperpigmentation of the skin, mucous membranes, and hair occurs when there are very high levels of ACTH.
The pigmentation changes associated with Cushing and Addison are due to increased levels of ACTH, not cortisol.
The pigmentation changes associated with Cushing and Addison are due to increased levels of ACTH, not aldosterone, which affects fluid balance.
The pigmentation changes associated with Cushing and Addison are due to increased levels of ACTH, not hypersensivity of melanocytes.

A 30-year-old female presents with hypertension, headache, tachycardia, impaired glucose tolerance, and weight loss. Which of the following diagnosis will the nurse see documented on the chart?
a.
Addison disease
b.
Conn disease
c.
Cushing disease
d.
Pheochromocytoma

D
Symptoms of pheochromocytoma include hypertension, palpitations, tachycardia, glucose intolerance, excessive sweating, and constipation.
Manifestations of Addison disease include weakness, fatigability, hypoglycemia and related metabolic problems, lowered response to stressors, hyperpigmentation, vitiligo, and manifestations of hypovolemia and hyperkalemia.
Hypertension and hypokalemia are the hallmarks of Conn disease.
Weight gain is the most common feature in Cushing disease and results from the accumulation of adipose tissue in the trunk, facial, and cervical areas. These characteristic patterns of fat deposition have been described as “truncal obesity,” “moon face,” and “buffalo hump.”

A nurse wants to determine if there is kidney dysfunction in a patient with diabetes. Which of the following is the earliest manifestation?
a.
Polyuria
b.
Glycosuria
c.
Microalbuminuria
d.
Decreased glomerular filtration

C
Microalbuminuria is the first manifestation of kidney dysfunction.
Polyuria occurs due to increased fluid in the vascular space, and microalbuminuria is the earliest manifestation.
Glycosuria occurs due to hyperglycemia, but microalbuminuria is the first sign of kidney dysfunction.
Decreased glomerular filtration can occur due to changes, but microalbuminuria is the first sign of kidney dysfunction.

Which of the following diseases should the nurse teach the patient to prevent as it is the ultimate cause of death in the patient with diabetes?
a.
Renal disease
b.
Stroke
c.
Cardiovascular disease
d.
Cancer

C
Cardiovascular disease is the ultimate cause of death in up to 75% of people with diabetes.
Cardiovascular, not renal, disease is the ultimate cause of death in up to 75% of people with diabetes.
Cardiovascular disease, not stroke, is the ultimate cause of death in up to 75% of people with diabetes.
Cardiovascular disease, not cancer, is the ultimate cause of death in up to 75% of people with diabetes.

A nurse is assessing a patient with hypoparathyroidism. Clinical manifestations of hypoparathyroidism include (select all that apply):
a.
Tetany
b.
Chvostek sign
c.
Trousseau sign
d.
Oily skin
e.
Hair loss

A, B, C, E
Symptoms of hypoparathyroidism includes tetany, Chvostek and Trousseau signs, dry (not oily) skin, and loss of body and scalp hair.